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RM.

12
RESUME / RINGKASAN KELUAR PASIEN RAWAT INAP
NO. REGISTER :
TGL. MASUK : JAM :
TGL. KELUAR : JAM :

IDENTITAS PASIEN
Nama Pasien : Jenis Kunjungan :
Tgl. Lahir / Umur : Nomor Kartu :
Jenis Kelamin : Penanggung Jawab Biaya :
Agama : Nomor Telepon :
Pekerjaan : Diagnosa Sementara :
Alamat : Diagnosa Medik :
Dokter Penanggung Jawab :
DIAGNOSA SELAMA : ............................................................................................................................................
DI RAWAT .............................................................................................................................................
DIAGNOSA AKHIR : ............................................................................................................................................
.............................................................................................................................................
RINGKASAN RIWAYAT PENEMUAN HASIL PEMERIKSAAN
RIWAYAT : ............................................................................................................................................
............................................................................................................................................................................................
TEMUAN FISIK : ............................................................................................................................................
............................................................................................................................................................................................
............................................................................................................................................................................................
HASIL DATA : 1. .......................................................................................................................................
PENUNJANG 2. ........................................................................................................................................
3. .........................................................................................................................................
4. .........................................................................................................................................
5. .........................................................................................................................................
PERKEMBANGAN : ............................................................................................................................................
SELAMA PERAWATAN .............................................................................................................................................
/ RAWAT INAP .............................................................................................................................................
KEADAAN : ............................................................................................................................................
PENDERITA, .............................................................................................................................................
PENGOBATAN, .............................................................................................................................................
KESIMPULAN SAAT .............................................................................................................................................
KELUAR RAWAT INAP
..........................................................2018
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